Cardiology Flashcards
(29 cards)
CCHD lesions that are usually cyanotic (7)
Hypoplastic left heart
Pulmonary atresia with intact ventricular septum
Total anomalous pulmonary venous return
ToF
Tricuspid atresia
Transposition of the great arteries
Truncus arteriosus
CCHD lesions that may be cyanotic (5)
Coarctation of the aorta
Double outlet right ventricle
Ebstein’s anomaly
Interrupted aortic arch
Defects with single ventricle physiology
What is a borderline screening result for pulse ox screening?
Sats 90-94%
> 3% difference between limbs
3 borderline readings 1 hour apart = a fail
Which mechanism of SVT is more common in
1. Newborns, infants, young children
2. Older children, adolescents, adults
- AVRT
- AVNRT
3 CXR findings seen in coarctation in older children
Cardiomegaly
3 or reverse 3 sign (notching of the aortic isthmus in the left superior mediastinum)
Rib notching (erosion of the ribs from large collaterals)
What genetic condition is commonly associated with coarctation?
Turner syndrome
Which cyanotic heart disease is the only one where pre-ductal sats are higher than post? Why?
Transposition of the great arteries
Blood from the LV is more cyanotic before it reaches the PDA where some mixing can occur
Rare other causes of reversed sats: preductal coarct, PDA with pHTN, supracardiac TAPVR with pHTN
Which cyanotic heart lesion gets worse with prostaglandin? Why?
TAPVR
Closing the PDA allows for more blood to flow systemically - with the PDA open mixed blood will continue to flow from the aorta to the pulmonary system and reduce the amount of blood going to the body
ALCAPA
Anomalous origin of the left coronary artery from the pulmonary artery
As pulmonary pressures fall you have inadequate perfusion to LV and then myocardial steal
Results in ischemia of the anterolateral LV wall
Can have infantile angina pectoris, HF
ECG shows infarct pattern (abnormal Q waves in 1, aVL, anterior leads)
Surgical repair needed
CXR findings for
1. TGA
2. TOF
3. Tricuspid atresia
4. TAPVR
5. Ebstein
- Egg on string
- Boot shaped, decreased pulmonary vasculature
- Enlarged RA, flat LV
- Snowman
- Wall to wall heart
ECG findings for ASD
RAE
Incomplete RBBB
Rheumatic fever criteria
JONES criteria
Major: polyarthritis, carditis, subcutaneous nodules, erythema marginatum, chorea
Minor: Arthralgia, increased ESR/CRP, prolonged PR interval, fever
Evidence of recent or current strep infection (throat culture or elevated/rising ASOT)
Need proof of infection and 2 major OR 1 major and 2 minor
How long to give prophylaxis for rheumatic fever
No carditis: 5 years or until 21 (whichever is longer)
Carditis, no residual heart disease: 10 years or until 21 (whichever is longer)
Carditis and residual heart disease: 10 years or until 40 (whichever is longer)
Chest pain red flags
Anginal, tearing, pleuritic pain
Exertional symptoms, activity intolerance
Palpitations, difficulty breathing
Exertional syncope
Hx of heart disease, Kawasaki, SCD
PE risk factors
Family history of arrhythmia, SCD, genetic disorder
Romano-Ward vs Jervell-Lange-Nielson
Both genetic causes of long QT
RW: AD
JLN: AR, associated with sensorineural deafness
How long of QTc is suggestive of a problem
> 470 ms
4 SEMs vs 3 holosystolic murmurs
SEMs: aortic stenosis, pulmonic stenosis, ASD, HOCM
Holosystolic: VSD, MR, TR
POTS criteria
Sustained HR of 40+ bpm within 10 mins of standing (2 readings)
No associated orthostatic hypotension
Symptoms of orthostatic intolerance
3+ months
Genetic associations with TOF
DiGeorge
T21, 13, 18
Alagille syndrome
CHARGE syndrome
Management for tet spells
Knees to chest (increases SVR)
Calm child, give O2 (decreases PVR)
Morphine, Beta blockers to slow HR
Na bicarb for acidosis
Positioning for venous hum vs Stills murmur
Hum: supra or infraclavicular regions, absent with supine, louder when upright, decreased when compressing jugular veins or turning head
Stills: LLSB, decreased when standing, expiration, louder when supine
Hum is louder on you bum, Still’s is louder when lying still!
Physiologic peripheral pulmonary stenosis
Results from increased blood flow to the lungs after birth
Resolves in 3-6 months
Grade 1-2 midsystolic ejection murmur
LUSB, radiation to back and axillae
PVC criteria for further investigation
2 or more in a row
Multiform
Increased with exercise
R on T pheomenon
Extreme frequency (> 20% on Holter)
Underlying heart disease and/or history of heart surgery
Who requires IE prophylaxis (6)
Prosthetic cardiac valve
Previous history of IE
Post cardiac transplant with valvulopathy
Unrepaired cyanotic heart disease
Completely repaired with prosthetic material for first 6 months
Repaired CHD with residual lesion
